title: Babies with brain damage who can not swallow: surgical management.
abstract: BACKGROUND
  Neonates with severe neurological impairment are often unable to swallow, necessitating gastrostomy for feeding. Because of the risk of developing severe reflux, this procedure is often associated with fundoplication.
  
  
  OBJECTIVE
  To assess the safety and efficacy of gastrostomy and Nissen fundoplication in 22 neonates with swallowing difficulties due to serious neurological impairment.
  
  
  METHODS
  All children underwent an initial period of nasogastric feeding and after informed consent underwent gastrostomy and Nissen fundoplication.
  
  
  RESULTS
  There were no significant intraoperative complications. There were two cases of postoperative periostomy leakage. Of the 22 neonates 16 were alive four months after surgery. Six neonates died of complications due to underlying disease.
  
  
  CONCLUSIONS
  We concluded that gastrostomy and Nissen fundoplication are safe procedures and help parents give a better care to these children.
authors.affiliation: Section of Neonatology, Department of Pediatrics Campinas State University, Campinas SP, Brazil.
authors.forename: Sidney V da
authors.initials: SV
authors.lastname: Silva
authors.forename: Augusto F S
authors.initials: AF
authors.lastname: Schmidt
authors.forename: Maria A
authors.initials: MA
authors.lastname: Mezzacappa
authors.forename: Sérgio T
authors.initials: ST
authors.lastname: Marba
authors.forename: Joaquim M
authors.initials: JM
authors.lastname: Bustorff-Silva
authors.forename: Lourenço
authors.initials: L
authors.lastname: Sbragia
mesh_terms: D001925:Brain Damage, Chronic / Q000150:complications*; D003680:Deglutition Disorders / Q000209:etiology* / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies